Paracetomol ineffective as treatment for back and joint pain.

Last week (April 2015) a study was published in the British Medical Journal that got a lot of headlines. An analysis of 13 quality trials showed that Paracetomol is no better than a placebo for treating back pain, arthritic pain and disability. What’s more, those patients regularly taking Paracetomol for back pain or arthritis were 4 times as likely to have abnormal results on liver function tests. So taking this medication for your pain will make you less healthy.

Similarly taking Non Steroidal Anti-inflammatories (NSAIDs) such as Ibuprofen and Naproxen can lead to health problems related to gastro-intestinal inflammation. Interestingly Aspirin did not cause inflammation of the small intestine (2). This inflammation leads to increased permeability of the intestine. If you consider that the intestine is the barrier between you and your food, bacteria and powerful enzymes it’s good to keep it healthy.

Do You Have A Leaky Gut?

If larger molecules cross the gut wall they can stimulate your immune system to attack them. Unfortunately, this reaction can then continue on similar molecules within you. Therefore increased gut permeability (caused by expression of a protein called Zonulin) contributes to the development of auto-immune diseases such as coeliac disease and diabetes type 1. (3) It has also been recently hypothesised that joint inflammation in relatively benign osteo-arthritis is also a product of this process. If that is the case then taking Nsaids could actually contribute to the cause of the problem you are taking it for.

How do you keep pain free then?

The research paper from the BMJ recommended exercise and manipulation to help stay pain free. Manipulation stimulates the nerves that regulate muscle tone and also inhibits pain. Most people will have pain from either over doing things or not doing enough. So if you are not active start by taking walks and then think about swimming, cycling and general workouts. Build up slowly over time and you will soon start feeling better. If you are a weekend warrior make sure you do regular consistent exercise to build up your conditioning or you will get injured. If you do have pain don’t take painkillers and NSAIDS. Use Ice, get help from an expert who understands biomechanics, athletic training, neurology, anatomy, diagnosis in other words us!! Don’t pop a pill, it will make you less healthy in the long run. If something’s wrong find out what and why and do something constructive about it. Your liver, kidneys and gut will thank you for it.

Taking Nsaids and exercising.

So, when you consider all of the above it is crazy to take paracetomol and anti-inflammatories as part of your training. Pain is there to warn you. If you listen to it properly it can be your best friend as it will keep you healthy and aware of issues before they become established. If you ignore your warning systems you are heading for trouble.

Is there an alternative to Nsaids?

Yes!! Studies have shown the efficacy of taking a concentrated turmeric formulation (4). Turmeric contains Curcumins which have been shown to reduce inflammatory cascades in the early phases of inflammation. It is not heat stable so cooking will nullify it’s effects. So a curry on the way home is not good practice. It won’t act instantly like a drug but is a useful supplement to help with a number of problems caused by inflammation if taken daily. We stock it as part of our holistic approach to improving musculo-skeletal health.

For more information on any of the above topics contact us on 01202 733355 or email us.

In the winter Vitamin D3 is the supplement you should be taking.

If I asked you what was the most important vitamin for fighting colds what would your answer be? Many people think it’s Vitamin C. It is certainly important in helping to mop up free radicals which cause damage through a process known as oxidative stress, but it’s not the most important. Vitamin D3 has been shown to boost immune function thereby helping you fight the invaders before they get a foot hold. To put it another way, Vitamin C helps you fight the effects of the chemicals released by inflammation, vitamin D3 helps to stop it in the first place.

What is Vitamin D3?

Vitamin D3 is synthesized in the skin when exposed to sunlight. Vitamin D2 is found in plants. Vitamin D has long been known to support the absorption of calcium and formation of bone. A deficiency leads to softening of the bones and Ricketts (bandy legs). This disease is on the increase again, due to people covering up for cultural reasons and lack of sunlight in higher latitudes, especially for those of darker skin.

What is it’s role?

More recently Vitamin D3′s role in immune function regulation has been studied extensively and new research is confirming it’s importance as a vital supplement. Poor immune function obviously can leave you more susceptible to infections such as the common cold and flu. It can also reduce your ability to recognise and destroy cancerous cells, and can lead to the development of auto-immune disorders where your immune system actually attacks your own body. This process has been implicated in some inflammatory arthritis, multiple scerosis, systemic lupus. A correlation has been found between low levels of Vitamin D3 and all of these disease processes. In addition macular degeneration (blindness), hayfever, chronic rhinitis have all shown signs of being affected by low vitamin D3 levels.

Are you getting enough?

This depends on your location, skin colour, diet and sun exposure. In the UK 90% of the population are below recommended levels. 75% of young adults are deemed deficient. 20-40% of young adults 19-24 years old, care home residents and children of British Asians have been found to have only a third of recommended levels. The amount needed varies according to who you read, the Endocrine Societies Clinical Practice Guidelines state from 400 iu to 800 iu as a daily requirement. With an optimum of 1000 iu to 1500 iu. In cases of deficiency 2000iu to 10000iu. You can read the guideline here. One thing is clear, if you are wrapped up for several months of the year in low sunlight you won’t be getting as much as in the summer.

Is this why you are more likely to have “bugs” in the winter? Is it also why cancers such as colo-rectal cancer are more common at higher lattitudes? There is also a possible link between latitude and multiple sclerosis and diabetes. Also have a look at this site which has a good deal more on the topic.

How do you top up?

Natural food sources are oily fish, such as salmon and sardines and eggs. It is also in fortified cereals, spreads and powdered milk. The NHS site states that most people should have enough, but latest clinical guidelines dispute this. Supplementation should be 1000iu for babies and children (be aware that baby formula milk commonly contains vitamin D, so adjust accordingly). 1500-2000iu for adults 18+ years of age.

Can You Test For It?

Generally because vitamin D deficiency is so widespread in the UK routine measurement is deemed unnecessary. A more cost-effective approach is routine supplementation with sensible sun exposure in the spring summer and autumn. High risk groups should be screened, these include people at high risk of inflammatory bowel disease, cystic fibrosis, gastric bypass patients and patients taking medication that effects vitamin D metabolism (anti-seizure meds, glucocorticoids, AIDS meds).

Can You Overdose?

Historically there have been concerns as very high levels can be toxic and cause too high a level of calcium and phosphate in the blood leading to bone conditions. However it is now well established that toxicity is extremely rare. Doses of up to 10,000iu a day have been used for up to 5 months with no adverse effects, suggesting that only long-term over supplementation is an issue. However it is important to stick to the guidelines.

Can’t I just get it from the sun?

If you live in northern latitudes, are inside alot and use sunscreen extensively you won’t get enough from the sun. Especially with our weather!

How can I take it?

There are many products on the market, I would recommend a natural food source variety and not a synthetic one. A quick search online should provide a wealth of information to help you choose.

It has long been a subject of hot debate between the medical profession and Chiropractors about the efficacy of longer term patient management programs. In a medico-socioeconomic model it has long been thought by the majority of the medical profession researchers that continual care for musculo-skeletal problems is not effective and that ongoing care is based purely on an economic basis for the benefit of the Chiropractor and not the patient.

This has on occasion put the professions at loggerheads when looking at care. It is important when considering this to question what is health? See previous post on this subject.

Slipping Once On Ice Is Unlucky But Not Getting Checked Out After Is A Second Slip Up!

With the recent cold snap we were all left taking tentative steps, for some the result was a crash down to earth. I saw 2 people do it myself. A fall onto one’s derriere at speed causes damage to the ligaments of the sacro-iliac joint and lower lumbar vertebrae.

In fact cadaver studies(1) show that as many as 20% have sustained damage to the lumbar interspinous ligaments that support the lumbar vertebrae.

This leads to increased motion at those levels and eventually disc degeneration and facet joint hypertrophy due to increased stress on these structures. The result down the line is possible nerve impingement and sciatica or in long standing cases stenosis (a narrowing of the central canal that the nerves run through).

These conditions can require surgery to prevent nerve damage, but in most cases people just have to accept that they can only walk a hundred yards or so before needing to sit and rest due to the cramp like pains they get in the calfs. Stenosis can also lead to bladder and bowel problems in old age.

Do you know someone like this? Do you know someone who’s slipped on the ice? Help them achieve a better old age by pointing them in the right direction. Fix it now and these issues can be reduced.

References:

1: Rissanen, P.M.(1960)The surgical anatomy and pathology of the supraspinous and interspinous ligaments of the lumbar spine with special reference to ligament ruptures. Acta Orthop Second, (Suppl.46)

A Look At Potential Pitfalls In A Festive Spirit.

It’s Christmas!!!

Well not quite, but the infamous words of Noddy Holder have probably been ringing out for a while now on the high street, but I wouldn’t know about that. Instead of doing this a bit at a time, I join the usual rush of stressed out men looking for that last minute present. So how do I keep from getting knots and aches when out? Buy vouchers and be done with it I hear you cry! Certainly an idea, but believe it or not I do carry bags and this is how I avoid the pains and aches over the Christmas period right up to New Year.

Tip 1: Take Your Time Shopping!!

But you said “I do it last minute”. That’s true, but I give myself time and before I shop, I mentally prepare myself by remembering that Christmas is about being festive. So while sauntering around and letting everyone else twist and duck and dive past I hum a carol or two and get in the spirit of things. How does this help? Stress will lead to increased tension and more likelihood of muscle strains. So relax and enjoy it.

Tip 2: Park Where It’s Easy To Get Back To From All The Shops. (Or do it Online)

You know how it is, you’ve already got a load of bags and the shoulders are feeling sore, but you’ll just pop into M & S for a few more bits, then you come out looking like a sherpa on the Himalayas.

Disc Prolapse Here We Come!

Well don’t do it, when you’ve got a few things take them back to the car, lock them in the boot and feel the tension go as you stroll back to your next target. Better still, do it online! (it’s not the same though is it, you’ll miss the joy of seeing someone wrapped in tinsell after the office party).

Tip 3: Wrap Up Warm.

Simple this one, if it’s freezing and windy you’ll immediately be more vulnerable to a muscle strain, wear a scarf and layers so if you get hot you can always take one off.

Tip 4: Rest Every Now And Then And Keep Hydrated.

Why not do this after dropping off the first load in the car, then you won’t have someone standing on Mum’s new cardy in the cafe. Have a warming drink and a snack to recharge your batteries, if it’s caffeinated make sure you have water though so you don’t dehydrate. Muscles are more likely to strain if dehydrated. If you had a sneaky sherry or mulled wine somewhere this is even more important!

Tip 5: Care When Lifting (or hiding it for that matter).

You’ve been out all day, hopefully not fed up and hungry, but full of joy as you don’t have to go back again for another year! You now have a boot full of presents, some wanted, some useless, but it’s the thought that counts. When you lift, pull things towards you and keep your lower back locked out. Don’t try and do it all at once if it’s heavy. The same goes for when you stuff it under the bed, at the top of the cupboard or in the loft, don’t twist and lift. Keep your back straight. We all know that one, but how often do you really take care when lifting?

Tip 6: Exercise! Even if in a queue!

I’m not expecting you to get on all fours, but there are a few exercises that you can do when stood in a queue that can really help your lower limb strength and stability. Firstly, as you’re wearing a big coat you can do buttock tenses and no one will be any the wiser as long as you remember to breath! Stand with legs shoulder width apart, and simply tense buttocks while gently pushing feet outwards while they stay firmly rooted to the floor, you can combine this by tensing the lower abs too. Remember to breathe!! Another is to stand feet shoulder apart, grip the floor with your feet, and lean forward slightly keeping your body rigidly straight. Do this until your heels just start to lift off the floor, think of Eddie “The Eagle” Edwards (ski jumper extraordinaire for those too young to remember). Hold both exercises for count of 5 and relax and repeat. If you spend an hour in a queue you’ll have had a great workout.

You don’t need to lean this far forward!

Tip 7: Sit Up Straight And Support Yourself.

Self explanatory really, you’ve had a few sherries, eaten too much, got bored with being cooped in with all the relatives, so you commandere the sofa or armchair and settle down for an assault on the chocolates, while watching a film you’ve seen before. Well, before that military manouveure make sure you have a cushion behind you, and if its a particularly soft sofa, have one underneath your hips as well so that they are level with your knees. Make sure you regularly get up and move around, even better go for a walk and stretch those legs. You’ll feel much better for it and it’ll help the lunch go down. If you’re having to travel, get out now and again and walk about too. Don’t lift your heavy bags straight after arriving, stand up for a while first, see our travel tips.

Tip 8: Never Play Twister!

There are occasions when this could be very beneficial, but best left to younger generations or students.

Tip 9: Care at Office Parties.

It’s pretty common to see a few self inflicted injuries due to overindulgence and temporary visual and reduced balance injuries! If your colleagues are dancing on the tables and you want to join them please make sure it’s sturdy, Limbo dancing is also best left to the professionals. Choose your dance partner wisely to avoid dislocated shoulders and whiplash.

Tip 10: Invest In Your Health.

Last and by no means least, if you’ve had problems before, have a check up so that you know you’re working better and not on the verge of an injury. Christmas time means less availability and it’s a time for enjoying yourself in the company of others. Don’t ruin it with a bad back or neck,pop in and make the most of it.

GPs are being advised to only use short courses of steroid injections to treat tendinopathies, after a systematic review found using them for longer can produce worse results than no treatment.

Instead they are being advised to use other methods of non-steroidal injections for treatment such as botulinum toxin and hyaluronic acid for conditions such as tennis elbow and other tendinopathies.

The extensive review – published in The Lancet – looked at 41 trials involving 2,672 patients and estimated the standardised mean differences between treatments and placebo.

Steroid administration was shown to be consistently effective over the short term but long term the benefit was unclear. For further information the full article can be found here, and the actual paper is here. Read more

“There is a high risk of poor long-term outcomes and higher recurrence rates with corticosteroid injections,” said lead author Bill Vicenzino, chair of sports physiotherapy in the School of Health and Rehabilitation Sciences at the University of Queensland.

“Other treatments, including exercise, some specific physiotherapy and possibly some other injections, should be used before corticosteroid injections,” Vicenzino said.

A Role For Medical Acupuncture?

A critical review by L.Viola of the literature showed some evidence of increased effectiveness of medical acupuncture over steroid injection, however the study sample quoted was limited and further research is required with larger samples.

A study by Val Jones published in Shoulder and elbow concluded that Acupuncture is frequently used by Chiropractors, physiotherapists in the management of chronic tennis elbow . However, the very few acupuncture studies to date have failed to prove conclusively that the short term relief in pain seen gives rise to long term functional improvement. No trials to date have assessed, concentrated or commented on the potential adverse effects of this particular form of treatment. The most recentCochrane review concludes there is insufficient evidence to support or refute the use of acupuncture. Further trials utilizing appropriate methodology and adequate sample sizes are needed before firm conclusions can be drawn regarding this treatment modality.

So Can Acupuncture Help?

In my opinion which is based solely on anecdotal cases, there is definitely a role for medical acupuncture in relieving short-term pain over general soft-tissue therapy alone. However it is likely that the combination of supportive taping, clasps, acupuncture, ice and heat therapy plus mobilisation and manipulation is probably the best route of care. This is due to the stimulation of repair, control of inflammation and restoration of accurate controlling reflexes.

From a personal view point just today I have been self administering acupuncture for a strain on my very own Tennis elbow, now I have to be disciplined and not play tennis tonight, pity as I was just starting to perfect my top-spin forehand, (probably wasn’t perfected, hence the injury). Physician heal thyself!!

This is a fundamentally important question when considering a “healthy” spine or body.

In the Western World health care is concerned mainly with getting you painfree, and unfortunately in general only lip service is paid to the preventative side of therapy. The commonest way of doing this is with medication until the pain goes, then you are healthy! This is fundamentally wrong and short-sighted.

Health is NOT an absence of symptoms, health is good function, everything working correctly, in a good environment, efficiently. Just focusing on being painfree will not result in good health.

In modern times we are all (well most of us) leading very busy lives, we are having to work harder, for longer, many of us travel ever increasing distances to work. We are under more pressure due to the cost of living, we have less time for ….

family and friends. There is an increase in the number of people being labeled as having behavioural disorders, ADHD, ADD etc and this is just a symptom of the environment that children are now being exposed to as a result of social changes that have taken place over the last 20 years.

All around the western world increasingly children are babysat with computer games or television, many complain of being bored in the holidays as many have reduced ability to partake in imaginative play.

There is a reason for this neurologically that relates to musculo-skeletal health, more on that in the next issue.

So what does western culture do about this growing epidemic? It gives it a name and medicalises what is essentially behavioural problems due to poor central nervous system stimulation. It prescribes drugs such as Prozac to make you “feel” better, but these drugs don’t make you better. Do you know that in the USA there is now a disease called shyness!! The cure? Prozac, but under a different name, how crazy is that?

Many of the serial killing gun sprees in America have been perpetrated by children who have been prescribed Serotonin re-uptake inhibitors SSRI’s. These affect the way the brain processes information and enhance the formation of repetitive patterns of activity, hence the multiple events. Consider also the relatively recent phenomenon of Fibromyalgia, how many people have you heard of that have been diagnosed with this condition. In my opinion this diagnosis should not be made as it labels individuals with a negative outlook that has detrimental effects on that persons prognosis, I’ll explain more on this subject in the next few entries.

I’m sorry if this is getting too morbid, but we really do have a health crisis on our hands if we don’t take steps to encourage children to explore imaginative play, exercise, challenging balance, eating well, communicating with friends and family, the same goes for adults too, although I’m not expecting you to get out the figurines from the attic if they are still there!

These are all positive feedback tasks that enhance and stimulate the central nervous system and lead to a sense of well-being.

Before I finish for now, ask yourself how you can make gentle, progressive and positive changes to your lifestyle that can help you feel better in general and also help you stay free of pain, both physical and emotional.

I’ll be covering the research on these subjects in the next few updates so do have a look soon. If you have children or are thinking of having them, this is information that you really should look at as a matter of utmost concern.

Are You Firing On All Cylinders?

In order for your body to move well with minimal effort and maximum control you need a nervous system that detects and modifies muscle tone accurately.

If there is poor detection of movement, the nerves fail to fire correctly or at the correct time, so the muscles cannot be contracted to protect your joints. Most of the time this will hardly be noticed, but you may feel a bit lethargic. If you play sport you may find you are a bit slower round the court or less accurate on the driving range.

Think of your body as a V10 Ferrari engine, now take off one of the HT leads (loss of spark to one cylinder), now slightly time another one wrong. The result a poorly engine that sounds bad and if pushed could get badly damaged. Fundamentally there’s nothing wrong with the engine but if it’s spark (nervous system) is not firing or out of time the result can be serious.

If you are feeling sluggish, or you’ve lost form in your sport you need to think about getting your muscles (engine) tested to get the timing back.

Chiropractic uses muscle testing to identify weaknesses and can use provocative challenges to accurately re-tune you. The result is you have increased power, work more efficiently and therefore have more stamina and also more accuracy. In short you could end up feeling great, when was the last time you felt great? Not after a bowl of Frosties I’m sure!!

Now if you then add in exercises that groove normal movement patterns, and build that up into strengthening and stamina building exercises which enhance the correct movement pattern, you have the recipe for a healthy musculo-skeletal system that is energy efficient.

In short you’ll be firing on all cylinders with a turbo-charger bolted on for good measure!

The Basics Of Back Pain Prevention

When you get low back pain it can be excruciating, it can also be quite frightening for the uninitiated. Most of the time the damage caused is actually slight and the body’s reaction is disproportionate to the damage present. The reason for this is due to the high sensitivity to pain, of the structures of the back. These are the facet joints and the capsule and ligaments that hold the vertebrae together.

When theses structures are stressed beyond their normal range due to poorly functioning muscles, excessive force or lax ligaments they send pain signals that cause a reflex contraction of muscle to splint and protect the joint from further damage. For further information click here.

When we don’t have back pain we tend to get lazy and take route one to pick things up etc. When you have back pain you don’t because the body won’t let you. This is the type of movement pattern that you should be striving for when you don’t have back pain.

So What Is That Movement Pattern?

Very simply it is using your body’s muscles to form a corset around the lumbar spine, or neck for that matter that gives stability and control to help protect the spine from any excessive motion. This co-contraction of the trunk flexors and extensors (stomach and back muscles) stabilises the spine and gives it support. This photo shows bracing of lower back and abdominal muscles to provide stability when sitting.

Correct bracing of lower back and abdominal muscles

How Do You Do It?

The easiest thing to do is tense your back muscles so that you hollow your back, then tense the abdominal (stomach) muscles as if you were avoiding someone poking you in the stomach. Then to bend, you have to flex from the hips and not the low back. If you have good Hamstring length you’ll only be able to get about 40 degrees of flexion, which means you’ll struggle to reach your knees!

Great, not very practical really is it? So you have to bend the knees if you want to get lower, but unless you were in the circus you still will struggle to reach the floor if you keep the back locked out. Especially if your hips are a little stiff. If you want to reach the floor you’ll probably have to flex the lower spine, but by this time your lower back will be supported a little by the thighs. To minimise stress further keep one leg flexed and kneel on the other, ie for tying up laces.

By the way can you spot what he is doing wrong? He is letting his head move forwards too far, he should be bracing his deep neck flexors as well. Click here to find out how to do this.

If you need to pick something up off the floor you can balance on one leg, lean forward from the hip and let your other leg counter balance you. Always a good idea to do this where you have a lot of space, or you could damage someone or something. Use a support for your free hand if there is one, like a golfer using his club to rest on when getting a ball out of the hole, but as I couldn’t find a photo of that here’s a close example of what I mean.

Building Resistance

You’ve Should Have The Flexibility Now It’s Time To Go For Strength And Stamina. Only complete this part if you can comfortably get your arms flat to the wall and keep them there as you lower them on the Wall Angel. Make sure you read this first if this is the first you’ve heard of Wall Angel.

You Need Equipment For This!!

What? Equipment? I hear you say. Never fear this is where the wonderful world of exercise bands come in to play. These are relatively inexpensive but highly versatile rubber bands, the beauty of these is that they improve your control of joint movement while under resistance. As the rubber is constantly working against you you have to work harder to control the bounce back so to speak. They come in a variety of resistances that are colour coded.

The other great thing about them is that they fold away and you won’t stubb your toes on them like a set of dumbells just hidden out of sight beneath the bed!

How To Add Stamina And Strength.

Take a two metre length of band and fold it over, start with a resistance that is comfortable. Remember no pain no gain is frankly a stupid way to train, so if you are struggling after just a few reps, get an easier band.

THIS IS ABOUT STAMINA PRIMARILY NOT POWER.

It’s great to be able to do a huge lift, but after one go you’re bust, what practical use is that in every day life?

Take the band as shown below between the hands and make sure you have some tension, then lower the arms and the band will stretch. Hold for a few secs, SLOWLY raise the arms back up, pause for a few seconds and repeat until you feel that you are starting to lose good form or begining to tire between the shoulders. Remember if you are getting pain, reduce the resistance, if it continues to give pain STOP, go back to unloaded exercise, i.e. no band.

Start position (arms are actually not bent enough!)

Ladies, a little advice…don’t do this before going out, it can do strange things to the hair on the back of your head and you may end up looking like this.

Aim to do the exercise once or twice a day with a rest break of 2 days in the week. If you require more assistance you can contact me through the clinic website.